王国栋　张腾　李强　　刘庆生

[摘要] 目的 探討大肠癌根治术后高龄患者肌少症与必需氨基酸的相关性，为此类患者的临床干预提供依据。 方法 收集2017年8月至2020年2月就诊于杭州市中医院老年病科符合入组标准的大肠癌切除术后的高龄患者。根据是否患有肌少症，将入组患者分为肌少症组与非肌少症组。收集两组患者的一般临床资料（包括年龄、性别、BMI、既往史等）。送检两组患者的血清必需氨基酸。利用单因素分析研究两组患者氨基酸之间的差异。利用Logistic多因素分析研究不同氨基酸与肌少症的相关性。利用ROC曲线分析不同氨基酸对肌少症的预测价值。结果 肌少症组亮氨酸、异亮氨酸、缬氨酸血清浓度低于非肌少症组，差异有统计学意义（P<0.05）。多因素分析提示，亮氨酸、异亮氨酸、缬氨酸可能是影响肌少症的因素（P<0.05）。ROC曲线提示，异亮氨酸、亮氨酸、缬氨酸对肌少症具有一定的预测价值（AUC亮氨酸=0.736，AUC异亮氨酸=0.706，AUC缬氨酸=0.726，P<0.05）。 结论 支链氨基酸缺乏可能是大肠癌术后高龄患者发生肌少症的危险因素。

[关键词] 高龄;肌少症;必需氨基酸;大肠癌

[中图分类号] R574.6          [文献标识码] B          [文章编号] 1673-9701（2021）09-0114-04

A prospective study on the correlation between essential amino acids and sarcopenia in elderly patients with colorectal cancer after resection

WANG Guodong1   ZHANG Teng2   LI Qiang3   LIU Qingsheng3

1.Department of Geriatrics，Dingqiao Hospital of Hangzhou City， Hangzhou   310000， China; 2.Department of Psychiatry， Hangzhou Seventh People′s Hospital， Hangzhou   310000， China; 3.Department of Geriatrics， Hangzhou Hospital of Traditional Chinese Medicine， Hangzhou   310000， China

[Abstract] Objective To explore the correlation between sarcoidosis and essential amino acids in elderly patients after radical resection of colorectal cancer， so as to provide evidence for clinical intervention in such patients. Methods Elderly patients admitted to the Geriatrics Department of Hangzhou Traditional Chinese Medicine Hospital from August 2017 to February 2020 who met the inclusion criteria after colorectal cancer resection were collected. According to whether they had sarcopenia or not，the patients were divided into sarcopenia group and non-sarcopenia group.General clinical data （including age， sex， BMI， past medical history， etc.） were collected for both groups. Serum essential amino acids of patients in both groups were examined.Single factor analysis was used to study the difference of amino acids between the two groups. Logistic multivariate analysis was used to study the correlation between different amino acids and sarcopenia. ROC curve was used to analyze the predictive value of different amino acids for sarcopenia. Results The serum concentrations of leucine， isoleucine and valine in the sarcopenia group were lower than those in the non-sarcopenia group， and the difference was statistically significant（P<0.05）. Multivariate analysis indicated that leucine， isoleucine and valine might be the factors affecting sarcopenia（P<0.05）. ROC curve indicated that isoleucine， leucine and valine had certain predictive value for sarcoid （AUC leucine=0.736， AUC isoleucine=0.706， AUC valine=0.726， P<0.05）. Conclusion Branched chain amino acid deficiency may be a risk factor for sarcopenia in elderly patients with colorectal cancer after operation.

[Key words] Advanced age; Sarcopenia; Essential amino acids; Colorectal cancer

大肠癌是危害人类健康的常见恶性肿瘤之一，发病率和死亡率均高居恶性肿瘤第三位[1]。手术切除是治疗大肠癌的主要方法。由于术后生理结构改变、肿瘤侵袭，大肠癌患者往往合并不同程度的营养不良，容易发生肌肉衰退及衰弱[2]。营养不良既是大肠癌不良愈后的诱因，也是发生肌少症的危险因素。肌少症是与年龄相关的一类疾病，特点为进行性全身肌肉数量减少及强度降低[3]。随着年龄增加，肌肉纤维逐渐流失，50岁以后每年肌肉纤维流失1%～2%，80岁时肌肉流失量可达30%。目前有研究表明，大肠癌术后发生肌少症可加重此类患者的不良预后，并且肌少症的发生与氨基酸缺乏密切相关[4]。……